37778 Federal Register / Vol. 63, No. 134 /Tuesday, July 14, 1998 /Rules and Regulations

Register of January 13, 1998, (63 FR

1919), the Office of Management and

Budget (‘‘OMB’’) control number is

incorrect. This correction replaces the

incorrect OMB control number.

In rule FR Doc. 98–743, published on

January 13, 1998, (63 FR 1919) make the

following correction. On page 1923, in

the first column, lines 2 and 3, remove

the words ‘‘control number 1506–0063’’

and add the words ‘‘control number

1505–0063 (redesignated by the Office

of Management and Budget as 1506–

0009).’’

Dated: July 8, 1998.

Peter Djinis,

Acting Director,

Financial Crimes Enforcement Network.

[FR Doc. 98–18659 Filed 7–13–98; 8:45 am]

BILLING CODE 4820–03–P

DEPARTMENT OF VETERANS

AFFAIRS

38 CFR Part 4

RIN 2900–AI46

Schedule for Rating Disabilities: Cold

Injuries

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

SUMMARY: This document amends the

Department of Veterans Affairs (VA)

Schedule for Rating Disabilities by

revising the provisions governing

evaluations for cold injury residuals.

The intended effect of this amendment

is to provide evaluation criteria based

on current medical knowledge about the

long-term effects of cold injury that can

be applied to any part of the body

affected by cold injury.

DATES: Effective Date: This amendment

is effective August 13, 1998.

FOR FURTHER INFORMATION CONTACT:

Caroll McBrine, M.D., Consultant,

Regulations Staff (211B), Compensation

and Pension Service, Veterans Benefits

Administration, Department of Veterans

Affairs, 810 Vermont Avenue NW,

Washington, DC 20420, (202) 273–7230.

SUPPLEMENTARY INFORMATION: In the

Federal Register of March 28, 1997 (62

FR 14832), we published a proposal to

revise the provisions of VA’s rating

schedule (38 CFR part 4) governing

evaluations for frozen feet (38 CFR

4.104, diagnostic code 7122). The

purpose of the proposal was to update

the evaluation criteria so that they

would be consistent with current

medical knowledge and encompass the

broad range of residuals now known to

result from cold injuries. We proposed

to retitle the diagnostic code from

residuals of frozen feet to residuals of

cold injury, to indicate that body parts

other than the feet could be included.

We invited interested persons to submit

written comments on the proposal.

As part of a final rule published in the

Federal Register of December 11, 1997

(62 FR 65207), which revised the

cardiovascular portion of the rating

schedule (38 CFR 4.104), we adopted

the revision proposed on March 28,

1997, with only minor changes.

However, we had received comments

from the Disabled American Veterans

and two interested individuals in

response to the March 28, 1997, notice

of proposed rulemaking. This document

responds to those comments and further

revises the rating schedule provisions

governing evaluations for cold injury

residuals.

One commenter suggested that in

rating decisions we change our method

of ‘‘coding’’ disabilities associated with

cold injury in order to identify the body

system or specific body part affected,

whether the affected body part is on the

left or right side, and the percentage

evaluation for each affected body part.

While the information the commenter

asks us to include is part of the written

rating decision, that information is not,

nor does it need to be, reflected by the

diagnostic code. The purpose of

diagnostic codes is merely to identify

disabilities for statistical purposes.

Diagnostic codes are numbers assigned

to each condition listed in the Schedule

for Rating Disabilities. Citation to a

diagnostic code in a rating decision

identifies the rating criteria used to

determine the evaluation assigned to a

particular disability and facilitates VA

statistical analysis. See 38 CFR 4.27.

Adopting the commenter’s suggestion

would have no substantive effect on

veterans’ disability ratings. We therefore

make no change in response to this

comment.

Another commenter submitted a copy

of a 1951 article entitled Cold Injuries in

Korea During Winter of 1950–51 by Lt.

Col. K. D. Orr, M.C., and Capt. D. C.

Fainer, M.C. The commenter maintains

that the study reflected in the article,

although flawed, is the basis of most

thinking regarding cold injuries and has

been used to miseducate doctors. The

commenter suggested that, rather than

focusing on ‘‘frostbite,’’ we take into

account the impact of extreme cold on

internal organs and define cold injury to

include a broad range of conditions,

including cardiovascular and

respiratory conditions, which he

contends are the long-term residuals of

hypothermia.

There has been considerable research

on cold injuries since 1951, when the

article to which the commenter refers

was published. Medical information

reviewed in developing the Veterans

Health Administration Information

Letter (IL 10–96–030, December 31,

1996) concerning the care and

examination of veterans with late effects

of cold injuries was the medical basis

for our revision of the evaluation criteria

for frostbite. The 1951 Orr-Fainer article

was not among the authorities cited in

the information letter.

Another commenter stated that VA’s

Adjudication Procedures Manual, M21–

1, Part VI, para. 11.20, mentions other

signs and symptoms, such as joint pain

and stiffness, weakness of hands or feet,

Raynaud’s phenomenon, and vascular

insufficiency, that may represent

chronic effects of cold injury. He

recommended that we include all of

these conditions in the evaluation

criteria for cold injury (diagnostic code

7122) so that the criteria are as

comprehensive as possible and do not

omit any symptoms that could be

attributed to cold injuries.

Simply because a condition could be

the result of cold injury does not mean

that it is the result of cold injury in a

given claim. All of the conditions

mentioned have other possible

etiologies, and it will require a medical

determination in each case to establish

whether a condition claimed as a

residual of a cold injury is the residual

of a cold injury. Furthermore, there are

so many conditions which could be

residuals of cold injury, that should we

attempt to provide a comprehensive list,

we might inadvertently omit conditions

that individual veterans might suffer as

a result of cold injury. Some of the

conditions mentioned by the

commenter, e.g., Raynaud’s

phenomenon, might well warrant higher

evaluations in their own right than the

maximum evaluation of 30 percent

allowed under diagnostic code 7122.

Therefore, rather than including those

conditions in the evaluation criteria for

cold injuries, we have revised note (1)

to indicate that such conditions may be

evaluated separately unless they are

used to support an evaluation under

diagnostic code 7122.

The same commenter suggested that,

since pain is one of the evaluation

criteria for cold injury residuals,

including arthralgia (joint pain) as well

is redundant.

Since the medical concept that

arthralgia may result from cold injury is

relatively new, we believe it is

important to specify that symptom in

the evaluation criteria along with the

less specific symptom of pain.
Federal Register / Vol. 63, No. 134 /Tuesday, July 14, 1998 /Rules and Regulations 37779

Nevertheless, we have revised that

portion of the criteria to clarify that

arthralgia is but one type of pain that

will satisfy that evaluation criterion.

We have made several nonsubstantive

technical corrections.

VA appreciates the comments

submitted in response to the proposed

rule. Based on the rationales presented

in the March 28, 1997, notice of

proposed rulemaking and the December

11, 1997, final rule that effected the

proposed revision, we affirm the

revision adopted in that final rule,

except for the changes made in this final

rule for the reasons explained above.

The Secretary hereby certifies that

this final rule will not have a significant

economic impact on a substantial

number of small entities as they are

defined in the Regulatory Flexibility

Act, 5 U.S.C. 601–612. The reason for

this certification is that this final rule

will not directly affect any small

entities. Only VA beneficiaries will be

directly affected. Therefore, pursuant to

5 U.S.C. 605(b), this final rule is exempt

from the initial and final regulatory

flexibility analysis requirements of

sections 603 and 604.

This final rule has been reviewed by

the Office of Management and Budget

under the provisions of Executive Order

12866, Regulatory Planning and Review,

dated September 30, 1993.

The Catalog of Federal Domestic

Assistance program numbers are 64.104

and 64.109.

List of Subjects in 38 CFR Part 4

Disability benefits, Individuals with

disabilities, Pensions, Veterans.

Approved: June 30, 1998.

Togo D. West, Jr.,

Secretary of Veterans Affairs.

For the reasons set out in the

preamble, 38 CFR part 4 is amended as

set forth below:

PART 4—SCHEDULE FOR RATING

DISABILITIES

1. The authority citation for part 4

continues to read as follows:

Authority: 38 U.S.C. 1155, unless

otherwise noted.

Subpart B—Disability Ratings

2. Section 4.104 is amended by

revising diagnostic code 7122 to read as

follows:

§ 4.104 Schedule of ratings—

cardiovascular system.

* * * * *

DISEASES OF THE ARTERIES AND

VEINS

Rating

* * * * *

7122 Cold injury residuals:

With the following in affected

parts:

Arthralgia or other pain, numbness, or cold sensitivity plus

two or more of the following:

tissue loss, nail abnormalities,

color changes, locally impaired sensation,

hyperhidrosis, X-ray abnormalities (osteoporosis, subarticular punched out lesions,

or osteoarthritis) ..................... 30

Arthralgia or other pain, numbness, or cold sensitivity plus

tissue loss, nail abnormalities,

color changes, locally impaired sensation, hyperhidro

sis, or X-ray abnormalities

(osteoporosis, subarticular

punched out lesions, or osteoarthritis) .................................. 20

Arthralgia or other pain, numbness, or cold sensitivity .......... 10

Note (1): Separately evaluate amputations

of fingers or toes, and complications such as

squamous cell carcinoma at the site of a cold

injury scar or peripheral neuropathy, under

other diagnostic codes. Separately evaluate

other disabilities that have been diagnosed as

the residual effects of cold injury, such as

Raynaud’s phenomenon, muscle atrophy, etc.,

unless they are used to support an evaluation

under diagnostic code 7122.

Note (2): Evaluate each affected part (e.g.,

hand, foot, ear, nose) separately and combine

the ratings in accordance with §§ 4.25 and

4.26.

* * * * *

(Authority: 38 U.S.C. 1155)

[FR Doc. 98–18642 Filed 7–13–98; 8:45 am]

BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS

AFFAIRS

38 CFR Part 17

RIN 2900–AJ34

Provision of Drugs and Medicines to

Certain Veterans in State Homes

AGENCY: Department of Veterans Affairs.

ACTION: Interim final rule with request

for comments.

SUMMARY: This document amends the

‘‘Medical’’ regulations concerning the

provision of drugs and medicines

prescribed by non-VA physicians for

certain veterans who are permanently

housebound or in need of regular aid

and attendance. The regulations are

amended to allow prescriptions to be

filled by non-VA pharmacies in state

homes under contract with VA for

filling prescriptions for patients in state

homes. This is consistent with VA’s

special relationship with state homes. It

will eliminate duplication of services

and will help improve timeliness for

filling prescriptions in state homes.

DATES: Effective Date: July 14, 1998.

Comment Date: Comments must be

received on or before September 14,

1998.

ADDRESSES: Mail or hand-deliver

written comments to: Director, Office of

Regulations Management (02D),

Department of Veterans Affairs, 810

Vermont Ave., NW, Room 1154,

Washington, DC 20420. Comments

should indicate that they are submitted

in response to ‘‘RIN: 2900–AJ34.’’ All

written comments received will be

available for public inspection at the

above address in the Office of

Regulations Management, Room 1158,

between the hours of 8:00 a.m. and 4:30

p.m., Monday through Friday (except

holidays).

FOR FURTHER INFORMATION CONTACT: Jeff

Ramirez, Pharmacy Service (119),

Veterans Health Administration,

Department of Veterans Affairs, 810

Vermont Avenue NW, Washington, DC

20420, (202) 273–8428. (This is not a

toll-free number.)

SUPPLEMENTARY INFORMATION: This

document amends the ‘‘Medical’’

regulations set forth at 38 CFR Part 17.

More specifically, it amends the

provisions of § 17.96 which concern the

criteria for providing drugs and

medicines prescribed by non-VA

physicians for certain veterans who are

permanently housebound or in need of

regular aid and attendance.

Prior to the effective date of this

document § 17.96 stated:

Any prescription, which is not part of

authorized Department of Veterans Affairs

hospital or outpatient care, for drugs and

medicines ordered by a private or nonDepartment of Veterans Affairs doctor of

medicine or doctor of osteopathy duly

licensed to practice in the jurisdiction where

the prescription is written, shall be filled by

a Department of Veterans Affairs pharmacy,

provided:

(a) The prescription is for:

(1) A veteran who by reason of being

permanently housebound or in need of

regular aid and attendance is in receipt of

increased compensation under 38 U.S.C.

chapter 11, or increased pension under

§ 3.1(u) (Section 306 Pension) or § 3.1(w)

(Improved Pension), of this title, as a veteran

of the Mexican Border Period, World War I,

World War II, the Korean Conflict, or the

Vietnam Era (or, although eligible for such

pension, is in receipt of compensation as the

greater benefit), or